Caring For Women

by Ann M. Colford


Back in the olden days -- say, 40 years ago, when I was a kid -- you'd never see the phrase, "women's health care." Mom saw the doctor when a baby was coming, and maybe she'd talk about "womanly" problems with him at her annual checkup, but that was about it.


Fortunately, we've made a few advances since then. With more women in the medical field and researchers finally realizing that gender really does make a difference in more issues than sex, the umbrella of women's health care now spans everything from traditional OB-GYN services to wellness and prevention programs.


Last year, Barnard College, the renowned women's college in New York, held a major summit on women and health that brought together doctors, writers, researchers and activists from around the globe. Among the key concerns raised by this illustrious gathering were the paired issues of poverty and access to decent health care, along with the need for more and better gender-specific research and treatments.


Globally and locally, access to appropriate care remains a critical issue. The Spokane Regional Health District estimates that 8 percent of the general population of Spokane County lacks health insurance at any given time. While eight percent sounds fairly small, that translates to nearly 34,000 people countywide. And the numbers climb if you look at the statistics over time; during the years 2000-02, more than 55,000 individuals in Spokane County were uninsured at some point. Add in the rural counties of Eastern Washington, and the numbers exceed 132,000. In Idaho, the numbers are even more bleak: More than 20 percent of the state's population, or about 252,000 people, are without health insurance.


Of course, access means more than insurance coverage. Many health care providers face financial difficulties due to changes in reimbursements and skyrocketing insurance rates, opening the door to a potential reduction in community resources. And even if you have medical insurance, navigating the system -- a thicket of pre-approvals, deductibles, co-pays, and unintelligible jargon -- to get appropriate care can be a challenge. For families without health insurance, even the most minor medical question raises agonizing financial choices.


Faced with these hurdles, women are becoming informed consumers and learning to advocate for themselves and their families. Locally, health care providers are working to bridge the gap between patients and services.





WOMEN AND HEART DISEASE


Ever since President Dwight Eisenhower suffered a heart attack


while in office in the 1950s, public awareness of men's risk for cardiovascular disease has been high. Fifty years of research has translated into some amazing advances in prevention, and men now live longer and healthier lives. Even this month's news of Bill Clinton's heart bypass surgery rang all the familiar bells -- a man between 40 and 60 with a rich diet, high stress and not enough exercise.


But what about women? Statistics show that cardiovascular disease is the leading cause of death for women over 50; more women die from heart-related ailments than from all types of cancer combined. Yet women tend to worry more about breast cancer than about their risk for developing cardiovascular disease. And because women exhibit different heart symptoms than men, they are less likely to receive appropriate cardiac screenings and treatments.


Most of our history of heart research has focused on men. The warning signs we all know -- the common risk factors -- all derive from research conducted largely on middle-aged men. Only recently have researchers begun to study women and their specific risk factors for illnesses including heart disease. And they're finding plenty of gender differences worth noting


"Women are dying because we don't [show] the cardiac symptoms that men do," says Sherry Maughan, director of the Women's Health Center at Sacred Heart. "Men often have chest pain and pain down their arms. Women can have headaches, heartburn or pain in the shoulder blades, but not necessarily pain that radiates down the arms. Most of us know those major symptoms in a man, but we don't know them for ourselves."


In addition, women often dismiss their own symptoms and delay getting the medical attention they need. When they do seek care, they're often misdiagnosed.


"I talked with a woman the other day who'd had symptoms for three days," Maughan recalls. "She thought that her chest hurt from heartburn and that she was tense and her shoulder blades were tight. When she got to the hospital after three days, she was in the middle of a cardiac incident."


To raise awareness of cardiovascular disease in women, the Women's Health Center began offering cardiac risk assessments through its Heart-to-Heart program last February. For a fee of $60, women receive a full series of screening tests (cholesterol levels, including HDL, LDL and triglycerides; fasting glucose levels; and body mass index), a computerized health risk assessment and a consultation with a cardiovascular nurse. Women not only learn their risk for developing cardiovascular disease, but they also receive recommendations for lifestyle changes that can reduce risk and improve overall health.


"We spend an hour with them and augment what their doctor does," says Brenda Covert, coordinator for the Women's Health Center. "We talk about ways to reduce their risk factors. For example, if a woman has a high body mass index and high cholesterol, we have other programs to support that. We might recommend a weight management support group or a consultation with a nutritionist."


Recent research focusing on women's cholesterol levels shows that the risk factors around high cholesterol may be different for women than for men. In men, the general rule has been to reduce LDL ("bad cholesterol") and total cholesterol while increasing HDL ("good cholesterol") levels. The biggest risk appeared to be associated with LDL levels. For women, the emphasis seems to be on raising HDL levels and maintaining a proper ratio between HDL and total cholesterol. In one study, the best predictor of heart disease risk for women was the ratio of total cholesterol to HDL.


"For women, we now recommend that HDL level be above 50, where for men it's above 40," says Covert. "For both, it's preferable to be above 60." An HDL measure above 60 is equivalent to negating one of a woman's other risk factors, she says.


Residents in North Idaho can access cardiac screenings and advice at the North Idaho Heart Center of Kootenai Medical Center in Coeur d'Alene. As of today, the Women's Heart Advantage program is being renamed and will be open to both men and women. Low-cost cardiac screenings at KMC will begin again in February, but the service is traveling to area businesses throughout the winter in an effort to make screening more convenient.





WOMEN AND CANCER


A diagnosis of cancer is one of the most devastating things for anyone to cope with. Advances in treatment mean higher rates of recovery for many cancers, but the process of fighting the disease can be frightening, confusing and lonely for patients and their families.


"Cancer affects women two ways -- either they get it, or they're caregivers to people who have it," says Jeanne Robison, ARNP, who leads clinical services of the Rockwood Cancer Treatment Center housed at Deaconess Hospital. The center opens this week to patients. "Not only will we offer multi-specialty care and help them with getting diagnosis and treatment, but we'll also be a resource center for anybody on the Deaconess campus."


For Robison, one of the most exciting features at the Center is the breast cancer tumor board, a weekly meeting of surgeons, oncologists, radiologists, nurses and technicians to review each case together and make treatment decisions as a group. (A similar group meets to review prostate cancer cases.) Another is her own work as a "cancer coach" to women who've just been diagnosed with the disease.


"We talk about what you do when you're newly diagnosed and how to make treatment decisions," she says. "A lot of women have questions about finances or legal issues, as well, so we'll connect them with a financial counselor."


The center also hosts a weekly breast cancer support group; anyone from the community who is in treatment or has completed treatment for breast cancer is welcome. The group meets every Wednesday at 9 am, except for the last Wednesday of the month, when the group convenes at 5:30 pm.


While the incidence of breast cancer remains relatively high -- 35 percent of cancers diagnosed in women in 2001 were breast cancer -- the good news is that newer, more aggressive treatments help more and more women survive the disease. In 2000, the national five-year survival rate overall for breast cancer was 89 percent. That probability goes up to 97 percent when the cancer is localized, leading health care providers to emphasize early detection and treatment.


To aid in early detection, Deaconess Hospital recently acquired needle biopsy equipment, allowing a less invasive biopsy procedure that more accurately pinpoints the location of tumors while the cancer is still small and easily treatable. In addition, the Rockwood Cancer Treatment Center now offers genetic counseling, risk assessment and prevention consultation to women at high risk to develop breast cancer.


The other two most common cancers in women are lung cancer and colon cancer, and the survivability rates for these illnesses are far more sobering. Lung cancer has the highest mortality rate of all cancers among both men and women, according to the Washington State Cancer Registry. Smoking -- and exposure to secondhand smoke -- is the No. 1 risk factor for lung cancer, followed by exposure to asbestos, radon and other carcinogens in the workplace. Tobacco use in Washington continues to drop, according to the American Lung Association of Washington, but about 1 million people statewide still light up.


"Breast cancer gets so much press, but in this area, we have a lot of lung cancer," Robison says. "We're lucky here at Rockwood to have Dr. Jay Wittenkeller whose interest is lung cancer. We're looking to open clinical trials around lung cancer, and we're getting a lot more drugs to treat lung cancer patients. Even if we can't cure the disease, the quality of life can improve with the new treatments."


In July, Dr. Corliss Newman -- a Spokane native who graduated from Ferris High School -- joined Rockwood, bringing along her experience and expertise in treating colon cancer. New drugs and treatment regimens developed in the past decade have raised the survivability rates for colon cancer, but early detection and treatment is the key to a successful outcome, Robison says.


Treatment for the "big three" cancers in women -- breast, lung and colon -- now relies on a combination of radiation, chemotherapy and hormone therapy. Patients often see one oncologist for radiation treatment plus their medical oncologist and perhaps other consultations for the management of symptoms like nausea and fatigue. The proximity of Rockwood's Cancer Treatment Center to Cancer Care Northwest's radiation oncology services, also located at Deaconess, helps to coordinate care and make treatment more convenient for patients.


"When people walk in here," Robison says, "we're going to take care of them, whatever it takes."





Heart Health Warning Signs





You may be at risk of having a heart attack -- or actually be having a heart attack -- if you feel:





Uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back





Pain that spreads to the shoulder, neck or arms





Chest discomfort with light-headedness, fainting, sweating, nausea or shortness of breath





Unusual chest, stomach or abdominal pain





Shortness of breath, difficulty breathing and dizziness





Unexplained anxiety, weakness or fatigue





Heart palpitations, cold sweat or paleness





These are the biggest risk factors for heart disease in women:





Smoking -- women who smoke increase their heart disease risk two to four times more than that of a nonsmoking woman.





High cholesterol -- research show that low levels of HDL ("good" cholesterol) appear to be a stronger risk factor for women than for men.





High blood pressure -- the most important risk factor for heart failure and stroke.





Physical inactivity -- 30 minutes of moderate intensity physical exercise a day will help gain heart health benefits





Obesity -- excess body weight in women is linked to congestive heart failure, stroke and death from heart-related causes.





Diabetes mellitus -- women with diabetes have from three to seven times greater risk of heart disease and heart attack and are at much greater risk of having a stroke.





Publication date: 09/30/04